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If large B-cell lymphoma comes back within a year, CAR-T should come before, not after, a transplant attempt.
This sequence rule says that when large B-cell lymphoma relapses within a year of first-line treatment, CAR-T cell therapy should be given before, not after, an attempt at high-dose therapy and autologous stem cell transplant. Chemorefractory disease rarely gets as far as transplant because it must first respond to salvage chemotherapy, whereas CAR-T does not require chemosensitivity. Two positive phase 3 trials, ZUMA-7 with axi-cel and TRANSFORM with liso-cel, showed better event-free survival for CAR-T than salvage chemotherapy plus transplant, and ZUMA-7 also showed an overall survival benefit; the negative BELINDA trial is explained by its design. Transplant remains the option for late relapses that respond to salvage.
TRANSFORM confirmed ZUMA-7's conclusion with a different CD19 CAR-T and a more permissive design that allowed bridging chemotherapy, making the results closer to real-world practice. Liso-cel's low toxicity makes it attractive for older or frailer patients and for outpatient delivery. Together the two trials made CAR-T the standard second-line therapy for early-relapsing aggressive lymphoma.
ZUMA-7 rewrote second-line treatment for aggressive lymphoma: patients whose disease returns within a year of R-CHOP should be offered CAR-T rather than salvage chemotherapy and transplant. It is also one of the few cell-therapy trials to show an overall survival benefit despite crossover. Patients relapsing later than 12 months were not studied and transplant remains standard for them if chemosensitive.
Shares BELINDA, TRANSFORM, ZUMA-7, Autologous stem cell transplant (high-dose therapy).
Shares ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early, ZUMA-7, CAR-T cell therapy, Diffuse large B-cell lymphoma.
Shares ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early, ZUMA-7, CAR-T cell therapy, Diffuse large B-cell lymphoma.
Shares BELINDA, TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma, TRANSFORM, ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early.
Shares BELINDA, TRANSFORM, ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early, ZUMA-7.
Shares BELINDA, TRANSFORM, ZUMA-7, Diffuse large B-cell lymphoma.
Shares BELINDA, TRANSFORM, ZUMA-7, CAR-T cell therapy.
Shares BELINDA, TRANSFORM, ZUMA-7, CAR-T cell therapy.